Exposure Control & Prevention Resources
What You Need to Know About Infectious Exposures
Public safety personnel can be easily exposed on the job to blood and other potentially infectious body fluids. Emergency responders may perform urgent, invasive procedures on unstable patients, treat open wounds, stop bleeding, encounter used needles or be assaulted. These events put them at increased risk for contracting bloodborne pathogen infections, including hepatitis B virus, hepatitis C virus, and human immunodeficiency virus (HIV) infections.
You can be exposed to bloodborne pathogens on the job by:
- Contact of your eyes, nose, mouth, or broken skin with blood or other potentially infectious materials.
- Needlesticks or cuts from sharp objects contaminated with blood or other body fluids.
- Injury from needles or other sharp objects during pat-down searches.
- Assaults—bites, cuts, or knife penetrations.
Other potentially infectious materials includes:
- The following human body fluids: semen, vaginal secretions, cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, saliva in dental procedures, any body fluid that is visibly contaminated with blood, and all body fluids in situations where it is difficult or impossible to differentiate between body fluids;
- Any unfixed tissue or organ (other than intact skin) from a human (living or dead); and
- HIV-containing cell or tissue cultures, organ cultures, and HIV- or HBV-containing culture medium or other solutions; and blood, organs, or other tissues from experimental animals infected with HIV or HBV.
Exposure transmissions can occur through:
- Direct transmission: occurs when microorganisms are transferred from an infected person to another person without a contaminated intermediate object or person.
- Indirect transmission: involves the transfer of an infectious agent through a contaminated intermediate object or person.
- Aerosolized airborne transmission: Person-to-person transmission of an infectious agent by an aerosol of small particles able to remain airborne for long periods of time. These can transmit diseases on air currents over long distances, cause prolonged airspace contamination, and can be inhaled into the trachea and lung.
Aerosolized airborne transmission may occur when public safety personnel share air space with a contagious individual who has an infectious disease caused by these pathogens. Such an individual can expel small droplets into the air through activities such as coughing, sneezing and talking. After water evaporates from the airborne droplets, the dried-out remnants can remain airborne as droplet nuclei.
- Aerosolized droplet transmission: Person-to-person transmission of an infectious agent by large particles only able to remain airborne for short periods of time. These generally transmit diseases through the air over short distances (approximately 6 feet), do not cause prolonged airspace contamination, and are too large to be inhaled into the trachea and lung.
Aerosolized droplet transmission may occur when public safety personnel come within about six feet of a contagious individual who has an infectious disease caused by these pathogens and who creates large respiratory droplets through activities such as sneezing, coughing, and talking.
- Bioterrorism or biological warfare: The Select Agents list maintained by the U.S. Department of Health and Human Services (HHS), lists biological agents and toxins that have the potential to pose a severe threat to human health and that may be used for or adapted for bioterrorist attacks.
In the setting of potential intentional modification to artificially increase transmissibility and/or lethality (“weaponization”) and deployment as bio-weapons (potentially in quantities far greater than would naturally be encountered), atypical pathways of transmission may occur. In this case, public safety personnel may be exposed by entering contaminated environments to care for victims and by exposure to contaminated individuals from those environments.
Click here to see a list of potentially life-threatening infectious diseases to which emergency response employees may be exposed, by transmission route
If you were exposed to blood or another body fluid, experienced a needlestick, or cut yourself with a sharp instrument, immediately follow these steps:
- Wash the site of the needlestick or cut with soap and water.
- Flush splashes to the nose, mouth, or skin with water.
- Irrigate eyes with clean water, saline, or sterile irrigants.
- Report the incident to your designated infection control officer, supervisor or the person in your practice responsible for managing exposures.
- Immediately seek medical evaluation from a qualified health care professional because, in some cases, postexposure treatment may be recommended and should be started as soon as possible.
Health care professionals who evaluate the exposures of public safety should be:
- Selected before public safety personnel are placed at risk of exposure.
- Experienced in providing antiretroviral therapy.
- Familiar with the unique nature of public safety injuries so they can provide appropriate guidance on the need for antiretroviral prophylaxis.
- Because not all exposure assessors are experienced in antiretroviral therapy, it may be necessary to identify more than one health care professional to perform these tasks.
Health care professionals caring for exposed public safety personnel can call the National Clinicians’ Post-exposure Prophylaxis Hotline (PEPline) for advice on managing occupational exposures to HIV and hepatitis B and C viruses. PEPline is available 24 hours a day, 7 days a week, at 1-888-448-4911.
Most exposures do not result in infection. Following a specific exposure, the risk of infection may vary with factors such as these:
- The pathogen involved
- The type of exposure
- The amount of blood involved in the exposure
- The amount of virus in the patient's blood at the time of exposure
Your employer should have in place a system for reporting exposures in order to quickly evaluate the risk of infection, inform you about treatments available to help prevent infection, monitor you for side effects of treatments, and determine if infection occurs. This may involve testing your blood and that of the source patient and offering appropriate postexposure treatment.
Immediate reporting to management of all potential exposures is important for the following reasons:
- Reporting allows you to provide appropriate, prompt, medical assessment and treatment. Exposures should be medically evaluated immediately (some treatments, such as for HIV exposure, should be started as soon as possible, preferably within hours).
- Reporting will help protect workers, their families, and the public. Infected workers who remain undiagnosed could place others, especially sexual partners, at risk of infection.
- HIV, HBV, and HCV have all been transmitted through broken skin; thus, these exposures have an infection risk and should be reported.
- Workers who develop occupational infections may not be eligible for workers’ compensation if the exposure has not been documented.
- By documenting exposures, you can identify causes and prevent them from occurring again. Employers need to know about exposures so they can implement effective prevention strategies, such as changing work practices, buying different safety devices or PPE, or improving employee training. This keeps workers on the job, reducing costs in the long run.
Why Are Employees Reluctant to Report Exposures?
Some employees are reluctant to report exposure incidents. Encourage your employees to report all exposures. This way, you can carry out your responsibility to take appropriate post-exposure actions to protect your workers, their families, and the public against infection from bloodborne pathogens.
Although rates of underreporting are difficult to ascertain, studies estimate that high percentages of workers do not report all exposures. Employees give many reasons for not reporting exposures:
- They do not think they will get an infection from the exposure.
- They think the exposure may have been their fault.
- They were not wearing the proper personal protective equipment.
- They are embarrassed by the exposure incident.
- They think it takes too much time away from work to report.
- They think reporting may result in a negative performance evaluation.
- They fear losing their job.
- They think that wiping blood or other body fluids off their skin is sufficient.
- They are not sure whether certain incidents should be considered exposures.
Are some of your workers failing to report exposures for these reasons? Encourage your workers to report possible exposure incidents as soon as possible.
How Can Agencies Encourage Reporting?
- Establish a policy that all potential exposures must be reported!
- Identify and address issues, workplace culture, or barriers that discourage reporting.
- Make sure employees know what an exposure is.
- Explain the risks of infection.
- Establish an easy-to-use system for reporting and evaluating exposures.
- Ensure reports are handled promptly and confidentially.
- Make sure all employees and managers understand the department’s reporting protocol.
- Cover reporting procedures in the initial and annual bloodborne pathogens training.
- Regularly remind your workers to promptly report all potential bloodborne pathogens exposures.
- Assure your employees that reporting an exposure will not affect their job or performance evaluation.
- Keep a record of exposures. Look for patterns of exposure and seek solutions to prevent future exposures.
- Show workers how reporting helps prevent future exposures.
Get the word out! Tell your employees about the policy, the steps you are taking to implement it, and how they can help.
This information was adapted from the NIOSH's Encourage Your Workers to Report Bloodborne Pathogen Exposures.
Follow these key tips to help prevent and protect yourself against harmful exposures:
- Follow Universal/Standard Precautions and other safety procedures
- Attend initial and annual bloodborne pathogens training.
- Read and understand your employer’s Exposure Control Plan.
- Use appropriate safety devices provided by your employer.
- Use safety needle and sharps devices whenever possible.
- Dispose of needles and sharps properly.
- Use caution when patting down a suspect.
- Use appropriate PPE provided by your employer. Use disposable gloves and other personal protection every time there is a potential for exposure to blood or body fluids.
- Avoid skin contact with blood, including on the arms.
- Wash skin visibly soiled with body fluids with soap and water.
- After skin contact with body fluids, even if skin is not visibly soiled, use antimicrobial soap and water or alcohol-based sanitizer.
- Report all exposures to blood and other potentially infectious materials to management.
- Get vaccinated against hepatitis B virus
Recommendations for Employers
- Have a written Exposure Control Plan and update it annually. These plans are required by the OSHA Bloodborne Pathogens Standard. A comprehensive bloodborne pathogens exposure prevention program will help protect your employees.
- Train employees about bloodborne pathogens, safe work practices, the proper use of safety devices and PPE, and other topics required by the Bloodborne Pathogens standard (29 CFR* 1910.1030). Include the opportunity for questions and answers with the trainer
- Provide effective medical safety devices and involve frontline workers in their selection.
- Provide appropriate PPE and encourage its use. PPE includes gloves; impermeable clothing; face shields or surgical face masks and eye protection; and mouthpieces, resuscitation bags, pocket masks, or other ventilation devices.
- Develop effective techniques for extricating patients from enclosed places, handling combative or uncooperative patients, and avoiding vomitus.
- Encourage workers to report all blood or body fluid exposures. Identify and address any barriers or attitudes that discourage reporting.
- Review exposures to identify patterns and opportunities for prevention. Inform workers of the findings.
- Implement a procedure for post-exposure evaluation and follow-up.
- Offer free hepatitis B virus vaccinations, and encourage workers to get vaccinated.
This information was adapted from the NIOSH's Preventing Exposures to Bloodborne Pathogens among Paramedics.
Unsure if you were exposed to an infectious disease?
to help you determine if you were potentially exposed and the next steps you should take.*
*Please note this is only a tool to assist you and your agency's existing exposure control plan. This tool is not intended to diagnose or replace professional medical advice. Always check with your designated infection control officer and Operational Medical Director for questions regarding exposure concerns and control procedures.
Protect Your Employees with an Exposure Control Plan
Your first line of defense against bloodborne pathogens.
A comprehensive bloodborne pathogens exposure prevention program will help protect your employees. One component of a bloodborne pathogens exposure prevention program is a written Exposure Control Plan.
These plans are required by the Occupational Safety and Health Administration (OSHA) Bloodborne Pathogens Standard. In addition, local regulations, employer policy, or collective bargaining agreements may call for such a program.
An Exposure Control Plan is the focal point of any bloodborne pathogens exposure prevention program. It details in writing your plan for reducing exposures to bloodborne pathogens and explains what steps to take when an exposure occurs. The Plan specifies all steps taken by your department to protect your workers.
Your Exposure Control Plan must be:
- Specific to your department
- Updated yearly
- Accessible to workers
First—and most important— your Exposure Control Plan helps you protect your frontline workers from exposure to bloodborne pathogens.
Second, if your workers are at risk for a bloodborne pathogens exposure, you may be required by the law to have a written Exposure Control Plan.
Third, the costs of an exposure incident can be significant, including post-exposure treatment and counseling, as well as loss of employee work time. If an employee does contract an illness, costs can dramatically escalate from increased worker’s compensation, lost work time, training of a replacement, etc. The Plan helps you control these costs by reducing exposures to bloodborne pathogens.
The basic elements of an Exposure Control Plan include:
- Written policy for protecting employees from bloodborne pathogens exposures
- Designated individual responsible for administering the Plan
- Employee exposure determination (a list of job classifications where employees may be exposed)
- Hepatitis B virus vaccination provisions
- Employee training (initial and annual training)
- Methods for control of bloodborne pathogens:
- Universal precautions
- Engineering controls (for example, safety devices and sharps containers)
- Work practice controls (for example, sharps handling and disposal, hand washing, cleanup)
- Personal protective equipment (for example, disposable gloves or face shields)
- Post-exposure reporting, evaluation, counseling, and follow-up procedures
- Procedures for evaluating circumstances surrounding an exposure incident
- Recordkeeping, including sharps injury logs, training records, and annual plan updates
Your Exposure Control Plan should include a description of how your department meets each of the basic elements. Your plan may also cover additional topics, such as how volunteers are protected.
OSHA presents a model Exposure Control Plan in its booklet Model Plans and Programs for the OSHA Bloodborne Pathogens and Hazard Communications Standards (2003), OSHA publication no. 3186-06R 2003. Use this model Plan as a template for your Plan, but tailor your Plan to the specific requirements of your department. If you already have a Plan, compare it to the model to ensure all elements are present. The model may give you ideas for improving your Plan during the annual update process.
The National Institute for Occupational Safety and Health (NIOSH) identified a number of problems with the Exposure Control Plans at fire, emergency medical services, and police departments. Here are some tips on how to avoid these problems. Review your Plan to see if it has any of these defects. If it does, revise the Plan to fix the problems.
- Provide a written plan. A written Exposure Control Plan is the basis for an effective bloodborne pathogens program. Update it annually.
- Tell workers that you have a plan and where it is located. During initial and annual bloodborne pathogens training, tell workers about the Exposure Control Plan and where they can find it.
- Designate a person to implement the Plan. Your Exposure Control Plan should identify a designated individual responsible for implementing the Plan.
- Do an “employee exposure determination.” Make one list of job titles where all employees have reasonably anticipated contact with blood or other potentially infectious materials and another list of job titles where specified tasks or procedures put some employees at risk of exposure.
- Provide safety devices. Provide safety devices engineered to prevent needlesticks and other sharps injuries to employees who use these devices. The use of these devices will help prevent exposures to blood.
- Get workers’ input in the selection of safety devices. Involve frontline employees in the evaluation and selection of safety devices. Document the selection process in your Exposure Control Plan.
- Be specific about how to implement controls. Your Exposure Control Plan should specify work practices to control exposures to bloodborne pathogens. For example, the Plan should cover decontamination of work surfaces and equipment and inspection and replacement of sharps disposal containers, including who is responsible for doing these tasks.
- Clarify how personal protective equipment (PPE) can help. The Exposure Control Plan should provide guidelines on when and how to use different types of PPE. PPE includes disposable gloves, other protective clothing, face and eye protection, and ventilation devices. Under normal conditions, PPE should not permit blood or body fluids to reach the workers’ skin, eyes, mouth, outer clothing, or undergarments.
- Encourage hepatitis B protection. Offer the vaccination series at no cost to employees after required training, which includes information on the vaccine. Vaccination is encouraged unless the employee has been previously vaccinated, is immune, or vaccination is not medically indicated. The Plan must also designate someone responsible for the vaccination program and include a vaccination declination form.
- Post-exposure evaluation and follow-up. Let employees know the procedure for reporting exposures, and have a plan for immediate medical evaluation and follow-up.
REMEMBER: Update your Exposure Control Plan every year, and get the updates into every copy! Make your Exposure Control Plan easily available to employees.
The following documents are intended to help agencies develop their infection control program and exposure notification and response policies and procedures:
- Model Plans and Programs for the OSHA Bloodborne Pathogens and Hazard Communications Standards: OSHA’s bloodborne pathogens standard protects employees who work in occupations where they are at risk of exposure to blood or other potentially infectious materials. This publication includes a model exposure control plan to meet the requirements of the OSHA bloodborne pathogens standard and a model hazard communication program to meet the requirements of the hazard communication standard.
- Guide To Managing An Emergency Service Infection Control Program: Since infection control requirements vary by agency type, local regulations, department size, etc., emergency response organizations cannot simply adopt a generic infection control program as their program. Therefore, this Guide is designed as a resource to help emergency response organizations tailor the requirements identified in regulations and standards to their own unique situations.
- The National Fire Protection Association (NFPA) 1581: This standard provides the minimum requirements for a fire department infection control program to identify and limit the potential of an infectious exposure to fire department members during the performance of their assigned duties and within the fire department working and living environment. While NFPA 1581 was written for fire departments, the guidance it contains is universally applicable for all responders and can be easily translated to fit any department’s needs.
- APIC's Guide to Infection Prevention in Emergency Medical Services: This guide is designed to help EMS system responders apply current scientific knowledge and best practices to improve targeted outcomes and enhance patient safety. Topics covered include: infection prevention standards, regulations, and best practices in patient and EMS system responder safety; instructions, examples, and tools to conduct surveillance and risk assessments; forms and templates for infection prevention education, training, and compliance monitoring; and emergency, disaster, and bioterrorism preparedness.
- EMS Infectious Disease Playbook: The aim of this resource is to unify multiple sources of information in a single planning document addressing the full spectrum of infectious agents to create a concise reference resource for EMS agencies developing their service policies. The information contained in this playbook is intended as a planning resource, and should be incorporated into agency standard operating procedures and reviewed by the EMS medical director.
- NIOSH Bloodborne Infectious Diseases: HIV/AIDS, Hepatitis B, Hepatitis C Website: The National Institute for Occupational Safety and Health's (NIOSH) website contains an abundance of resources related to controlling and preventing bloodborne infectious diseases.
- CDC - Protecting Healthcare Personnel: The resources on this page are intended to promote patient safety and increase the safety of the healthcare work environment from bloodborne infectious diseases.
- Designing, Implementing & Evaluating a Sharps Injury Prevention Program: An effective sharps injury prevention program includes several components that must work in concert to prevent healthcare personnel from suffering needlesticks and other sharps-related injuries. This program plan is designed to be integrated into existing performance improvement, infection control, and safety programs.
- Stop Sticks Campaign: Maintained by the National Occupational Research Agenda (NORA) Healthcare and Social Assistance Sector Council, the Stop Sticks campaign is a communication intervention aimed at raising awareness among health care workers about their risk of workplace exposure to bloodborne pathogens from needlesticks and other sharps related injuries.
Disease Exposure Control Planning Law and Policies
- Virginia Regulations for Disease Reporting and Control: The Regulations for Disease Reporting and Control describe what diseases must be reported to the health department and the methods to use to report. Cases of disease have been reported to the Virginia health department since the early part of this century. Beginning in 1919, the Code of Virginia has required the State Board of Health to promulgate a list of diseases that must be reported. The enclosed regulations represent the Board’s latest response to this mandate.
- OSHA's Bloodborne Pathogens Standard Website: This page contains a multitude of resources outlining the requirements of OSHA's Bloodborne Pathogens Standard (29 CFR 1910.1030).
- Infectious Diseases and Circumstances Relevant to Notification of Emergency Response Employees: Implementation of Sec. 2695 of the Ryan White HIV/AIDS Treatment Extension Act of 2009: This documents has two purposes: (1) to identify those potentially life-threatening infectious diseases to which emergency response employees (EREs) may be exposed in responding to emergencies, and (2) describe the steps that medical facilities should follow to notify EREs to allow for the timely diagnosis and post-exposure medical treatment of those exposures.
- Ryan White HIV/AIDS Treatment Extension Act of 2009 Website: NIOSH's website provides additional information and resources about the Ryan White act.
Specific Infectious Disease Resources
- NIOSH - HIV/AIDS, Hepatitis B & C: NIOSH's website provides resources and information about HIV/AIDS, Hepatitis B & C.
- Covid-19 Resources: Check out the Office of EMS's COVID-19 page to find the latest health and safety information for EMS providers.
- EMS Pandemic Influenza Guidelines for Statewide Adoption: This document provides broad-based Pandemic Influenza Guidelines for consideration by State and local emergency medical services agencies.
- Transporting Suspected / Confirmed Ebola Patients: This document provides agencies guidance for developing plans for the interfacility, transport of persons under investigation, or patients with confirmed Ebola virus disease.
Hazardous Materials Exposure Prevention and Response
- Emergency Response Guidebook: U.S. Pipeline and Hazardous Materials Safety Administration's Emergency Response Guidebook provides first responders with a go-to manual to help deal with hazmat transportation accidents during the critical first 30 minutes.
- Nerve Agent Information for EMS: This document provides a quick refresher on standard protocols for recognizing, treating, and protecting yourself from nerve agent exposures.
- PPE Requirments: OSHA's "Best Practices for Protecting EMS Responders during Treatment and Transport of Victims of Hazardous Substance Releases" details how to best protect providers transporting patients who have been exposed to hazardous substances.
Designated Infection Control Officer Training
**As of December 31, 2019, the Virginia Office of EMS (OEMS) does not identify, approve, or endorse specific Infection Control Officer educational programs. Virginia licensed EMS agencies may select a training program of their choice to ensure their agency's DICO has received training that is compliant with OSHA Bloodborne Pathogens Standard 29 CFR 1910.1030 and any other federal regulation(s) that may apply. Click here to learn more.
Recommended Vaccine Resources
- VDH's Healthcare Personnel (HCP) and Vaccinations Recommendations & Requirements: This page contains information about which vaccines are recommended for healthcare personnel and laws and regulations concerning HCP vaccinations.
- CDC's Recommended Vaccines for Healthcare Workers: This page contains the CDC's vaccine recommendations for healthcare workers and specific information on the various vaccines.
- COVID-19 Vaccination Resources: information regarding the COVID-19 vaccine from the Virginia Department of Health, the Centers for Disease Control and Prevention, and the U.S. Food and Drug Administration.
Laws and Regulations Concerning Healthcare Personnel Vaccinations
- Federal regulations through the Occupational Safety and Health Administration (OSHA)’s Bloodborne Pathogen Standard 1910.1030(f)require employers to offer the hepatitis B vaccination to all employees who have anticipated contact with blood and other potentially infectious materials. The vaccination should be offered at no cost, after the employee has received training, and within 10 days of initial assignment to a job where there is occupational exposure, unless the worker has previously received the vaccine series, antibody testing has revealed the worker is immune or the vaccine is contraindicated for medical reasons.
- The vaccination series must be provided in accordance with the recommendations of the U.S. Public Health Service current at the time of the vaccination. This includes follow-up testing one to two months after the completion of the three-dose vaccination series to test for antibody to hepatitis B surface antigen.
- OSHA Fact Sheet on Hepatitis B Vaccination Protection
- The Virginia Occupational Safety and Health (VOSH) Program has adopted the federal OSHA standard and has incorporated it by reference into the Virginia Administrative Code (16VAC25-90-1910). When Virginia adopts federal OSHA standards such as the 1910.1030 Bloodborne Pathogen Standard, they become state law and the VOSH Program has the authority to enforce them in public and private sector workplaces.
- Besides hepatitis B vaccination as discussed above, there are no other state laws or regulations requiring vaccinations specifically for HCP in the Commonwealth of Virginia.
- As a best practice, immunization coverage assessments should be performed upon hire and annually to ensure HCP are immunized appropriately.
- Workers may be subject to the vaccine requirements put in place by their respective employers.
- Students, interns and trainees in healthcare settings may be subject to the vaccine requirements established by their college/university or training program. Vaccine recommendations may reflect guidance from The American College Health Association.
- HCP without documented vaccination or immunity may be furloughed at the recommendation of the health department and/or employer in the event of an outbreak or disease exposure of public health importance.
- Some State regulations provide for facilities to establish infection control policies that may include HCP vaccination. Here are some examples:
- State regulations 12VAC5-410-490 provide that hospitals shall have an infection control committee to “develop, periodically evaluate, and revise as needed, infection control policies, procedures, and techniques” that “shall include, but are not limited to, appropriate employee health screening and immunization.”
- State regulations 22VAC40-72-90 provides that assisted living facilities “shall establish and maintain an infection control program” that is designed to “prevent the development and transmission of disease and infection.”
About Virginia's Exposure Control & Prevention Initiative
Exposure to infectious diseases is a serious threat to first responders. At the request of the General Assembly of Virginia, a workgroup was established to improve the Commonwealth's response to exposure-prone incidents involving public safety employees. The goal of the workgroup is to develop and establish unified exposure control and prevention plans, guidance, and resources for all public safety personnel. The workgroup consists of representatives from law enforcement agencies, fire departments and companies, emergency medical services agencies, and other appropriate entities.
If you have any information or suggestions you would like to share with the workgroup, please contact Karen Owens, Emergency Operations Manager, at Karen.Owens@vdh.virginia.gov.